FMCSA Consortium

FMCSA Consortium

Louisiana Occupational Health Services
DOT/FMCSA DRUG AND ALCOHOL CONSORTIUM

LOHS is now offering a consortium service to help manage all, or part, of an employer’s DOT drug and alcohol testing program. When partnering with a consortium, we can help you stay in compliance and aid in other areas of DOT/FMCSA rules and regulations. A consortium takes the Random Drug and Alcohol selection out of the company’s hands, to help avoid any conflicts between employee and employer.

The Department of Transportation (DOT) guidelines 49 CFR Part 40 describes required rules and regulations for DOT/FMCSA drug and alcohol policies for companies. All DOT/FMCSA regulated companies are required to have a DOT compliant drug and alcohol program in place. A DOT drug and alcohol testing program is mandatory for any company or owner-operator that employs workers in a safety-sensitive position.

LOHS CONSORTIUM MEMBERSHIP INCLUDES
• Drug and Alcohol Testing Services (Options of at LOHS (in Alexandria) or collection services at a clinic near you)
• Manage Drug and Alcohol Random Pool Program
• Maintain Drug and Alcohol Program Records
• Certificate of Consortium Enrollment
• SAP Referral
• MRO Services
ANNUAL CONSORTIUM MEMBERSHIP FEE - NO MONTHLY FEES
- $99.00 per enrolled year/per driver (this is the price for Non-DOT employees as well)
Additional Service Fees
- $75.00 Supervisor Reasonable Suspicion Training Course
- $25.00 Custom Drug and Alcohol Policy
- $35.00 MRO fee if specimen is not collected at LOHS
- DOT Drug Screen - $50.00 @ LOHS
- DOT Breath Alcohol - $20.00 @ LOHS
- MRO - $35.00 (fee if collection is performed outside of LOHS)
*It is REQUIRED all ennrolling driver must have a NEW DOT Pre-Employment drug screen performed to complete the driver’s enrollment. LOHS does offer the service of ON-SITE testing (pending location) for new enrollments if more than 10 employees need to be tested. All added or dropped drivers must be reported to LOHS at time of hire or termination. Randoms will be pulled quarterly, and you will be contacted if any drivers are chosen. No refund will be issued due to cancelation of enrollment.

*If your company is not local to Central Louisiana, drug screen Chain of Custody forms will be mailed to you for use at other DOT certified collection sites near you.
Louisiana Occupational Health Services - 3018 Jackson St., St.100, Alexandria, LA 71301

P:(318)561-8200 F:(318)561-8204 www.lohs.net

FMCSA Consortium Account Information

Louisiana Occupational Health Services
Company Name *
DBA
Contact Person*

First NameLast Name
Title
Tax ID#*
DOT#
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Restricted Release Information
I authorize the below personnel, ONLY, to obtain employee medical information and/or drug screen results via email, fax, and/or verbal reports from Louisiana Occupational Health Services. I confirm the below personnel will maintain confidentiality with regards to any and all reports received. The company agrees to update this form in the event any authorized personnel changes are made. All medical information and drug screen results will be PORTAL ACCESS or EMAILED to the following personnel. Please select which option(s) are preferred. NOTE: If you choose to utilize our PORTAL for RESULTING please select PORTAL in the result source below and we will get it set up for you.
Select ONE Result Source*
Authorized Personnel to receive Employee Medical Information*

First NameLast Name
Email for resulting or portal access to be sent to.*
example@example.com

DOT CONSORTIUM ENROLLMENT LIST

Louisiana Occupational Health Services
LIST EMPLOYEES NEEDING TO BE ENROLLED
DOT Employee List - $99.00 per driver/per year
Do any DOT Supervisors need to take the Reasonable Suspicion training course? (Required by DOT for all Supervisors) - $75.00 per course*
How many Reasonable Suspicion training courses do you need?
# of Supervisors in need of the course
Do you need to enroll any Non-DOT employees?
List Non-DOT Employee Below- $99.00 per Non-DOT employee/per year
Authorized Representative*

First NameLast Name
Authorized Representative Signature*

Clear
Date*

MonthDayYear
Date
Louisiana Occupational Health Services - 3018 Jackson St., St.100, Alexandria, LA 71301

P:(318)561-8200 F:(318)561-8204 www.lohs.net
Should be Empty:

FMCSA Consortium

FMCSA Consortium Account Information

Restricted Release Information

DOT CONSORTIUM ENROLLMENT LIST

LIST EMPLOYEES NEEDING TO BE ENROLLED